Bone plate system and method

ABSTRACT

A bone plate system is provided that permits rapid, secure stabilization of a plurality of bones, such as portions of a cut rib. The bone plate system includes a bone plate having anchor devices for securing the bone plate to, for example, cortical bone of the cut rib portions. The anchor devices have an open configuration that permits the anchor devices to be connected to the cortical bone of the cut rib portions and a clamping configuration that fixes the bone plate to the cortical bone of the cut portions. The bone plate connects the cut rib portions and stabilizes the cut rib portions against relative movement therebetween.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.61/912,246, filed Dec. 5, 2013, which is hereby incorporated byreference in its entirety herein.

FIELD OF THE INVENTION

The invention relates to bone plate systems and, more particularly, tobone plate systems for stabilizing one or more bones.

BACKGROUND OF THE INVENTION

There are presently many different types of bone plate systems forsecuring bones so that the secured bones may fuse or heal. As usedherein, the term bone may refer to a bone, a bone fragment, or a portionof a bone. One application for bone plate systems is for securing brokenor fractured bones so that they may fuse together. Another applicationfor bone plate systems is securing cut bones, such as during athoracotomy. A thoracotomy may involve cutting one or more ribs and, insome instances, removing a section of one or more ribs in order toprovide access to tissues and organs within the chest cavity of apatient.

After the tissues or organs within the chest cavity have been operatedupon, the cut rib(s) of the patient may be repaired. For example, if onerib has been cut, a bone plate and screws may be used to secure theportions of the cut rib together. However, ribs are relatively thin andconsist of soft cancellous bone enclosed in a thin, compact layer ofhard cortical bone. Driving the screws of the bone plate into theportions of the cut rib exerts an outward pressure upon the bone whichmay splinter the bone. Further, in order to achieve sufficient purchasein the bone, the screws may need to be driven completely through bothlayers of cortical bone and the cancellous bone therebetween. This maycause a portion of a screw shank to extend beyond the rib and irritatetissues within the chest cavity.

Another problem is that each rib has a delicate neurovascular bundle ofa vein, an artery, and a nerve extending along the underside of the rib.The presence of the neurovascular bundle on the underside of a ribfurther complicates the placement of bone plate systems after the ribhas been broken or cut.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a bone plate system including a boneplate having pairs of jaws;

FIG. 2 is a cross-sectional view taken across line 2-2 in FIG. 1 showingthe bone plate securing two portions of a cut rib together;

FIG. 3 is a front elevational view of the bone plate of FIG. 1 showingthe jaws of the bone plate in an initial, undeflected configuration;

FIG. 4 is a front elevational view similar to FIG. 3 showing the jaws ofthe bone plate in a deflected, open configuration;

FIGS. 4A and 4B are cross-sectional views similar to FIG. 2 showing thebone plate being connected to the rib portions;

FIG. 5 is a plan view of an inserter tool and the bone plate of FIG. 1mounted in a tray;

FIG. 6 is a front elevational view of a lever of the inserter toolshowing a foot of the tool having a fulcrum at a heel of the foot and astud at a toe of the foot;

FIG. 7 is a bottom plan view of the lever of FIG. 6 showing a bottomsurface of the foot extending between the fulcrum and the stud;

FIG. 8 is a side elevational view of the lever of FIG. 6 showing asurface for abutting the other lever of the inserter tool;

FIG. 9 is a schematic view of the inserter tool of FIG. 5 being used tomaintain upper jaws of the bone plate of FIG. 1 in the deflected, openconfiguration and connect the jaws to cut rib portions;

FIG. 10 is a side elevational view of the bone plate system of FIG. 1showing the bone plate securing rib portions and teeth of the bone plateengaged with exterior surfaces of the rib portions;

FIG. 11 is a top plan view of the bone plate and rib portions of FIG. 10showing openings at tips of the bone plate jaws for engaging the studsof the inserter tool levers;

FIG. 12 is cross-sectional view taken across line 12-12 in FIG. 11showing a large, unobstructed surface area of cortical bone of the ribportion for fusing with the cortical bone of the other rib portion;

FIG. 13 is a front elevational view of another bone plate system showinga bone plate having arms in an initial, undeflected configuration;

FIG. 14 is a cross-sectional view of the bone plate of FIG. 13 showingthe bone plate received within the intramedullary canal of a cut rib;

FIG. 15 is a front elevational view of another bone plate system havinga bone plate and clamp screws carried on the bone plate;

FIG. 16 is a cross-sectional view of the bone plate system of FIG. 15showing the bone plate system stabilizing a cut rib;

FIG. 17 is a cross-sectional view of another bone plate system includinga bone plate having a pair of bolts for adjusting the position of jawsof the bone plate;

FIG. 18 is a cross-sectional view similar to FIG. 17 showing the jaws ofthe bone plate shifted to an open configuration;

FIG. 19 is a front elevational view of another bone plate systemincluding a bone plate having a support sized to position jaws of thebone plate on anterior and posterior exterior surfaces of a cut rib;

FIG. 19A is a bottom plan view of the bone plate system of FIG. 19showing the bone plate stabilizing a cut rib and the jaws of the boneplate spaced from a neurovascular bundle running along an underside ofthe rib;

FIG. 20 is a cross-sectional view of the bone plate of FIG. 19 showing acentral bone growth window of the bone plate;

FIG. 21 is a front elevational view of another bone plate systemincluding a bone plate having jaws configured to engage anterior andposterior exterior surfaces of a cut rib and an intramedullary canalbrace extending outwardly between the jaws;

FIG. 22 is a cross-sectional view of the bone plate system of FIG. 21showing a bone growth window of the bone plate extending through thebone plate;

FIG. 23 is a perspective view of another bone plate system including abone plate with resilient arms;

FIG. 24 is a front elevational view of the bone plate system of FIG. 23showing teeth of the bone plate configured to resist removal of the boneplate from the intramedullary canal of a cut rib;

FIG. 25 is a top plan view of the bone plate system of FIG. 23 showingan enlarged, central portion of the bone plate and narrow leading endportions of the bone plate;

FIG. 26 is a front elevational view of another bone plate system havinga bone plate configured to engage anterior and posterior exteriorsurfaces of a rib;

FIG. 27 is a bottom plan view of the bone plate of FIG. 26 showing jawsof the bone plate;

FIG. 28 is a side elevational view of the bone plate of FIG. 26 showingthe bone plate being positioned onto a cut rib;

FIG. 29 is a top plan view of the bone plate of FIG. 26 showing a cutoutbetween upper jaws of the bone plate;

FIG. 29A is a side elevational view of another bone plate systemincluding a bone plate having a hinge and locking device;

FIG. 30 is a perspective view of another bone plate system showing thebone plate system stabilizing portions of a broken clavicle bone;

FIG. 31 is a perspective view of the bone plate system of FIG. 30showing two bone anchors and a cable of the bone plate system removed;

FIG. 32 is a front elevational view of the bone plate of FIG. 31 showinga cable of the bone plate system looped around a seat of the bone plate;

FIG. 33 is a rear elevational view of the bone plate of FIG. 31 showinglengths of the cable extending outward from openings of the bone plate;

FIG. 34 is a top plan view of the bone plate of FIG. 31 showing a clampbody holding end portions of the cable and the loop of the cable againstthe bone plate;

FIG. 35 is a cross-sectional view taken across line 35-35 in FIG. 34showing an arm of the clamp body capturing the loop of the cable on thebone plate seat;

FIG. 36 is a cross-sectional view taken across line 36-36 in FIG. 34showing the clamp body clamping end portions of the cable against thebone plate;

FIG. 37 is a top plan view of the bone plate of FIG. 30 showing recessesof the bone plate configured to receive the clamp bodies;

FIG. 38 is a perspective view of the bone plate of FIG. 30 showinggrooves of the bone plate recesses for receiving end portions of thecables below the clamp bodies;

FIG. 39 is a perspective view of one of the clamp bodies of the boneplate of FIG. 30 showing clamping members of the clamp body;

FIG. 40 is a front elevational view of the clamp body of FIG. 39 showingthe clamping members extending outward from a body portion of the clampbody;

FIG. 41 is a side elevational view of the clamp body of FIG. 39 showinga concave lower surface of the clamp body arm; and

FIGS. 42-46 are schematic views of a method of securing the bone platesystem of FIG. 30 to portions of a cut clavicle bone.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

With respect to FIGS. 1 and 2, a bone plate system 10 is provided thatpermits rapid, secure stabilization of a plurality of bone portions,such as portions 38, 40 of rib 39 separated by a break or cut 39A. Thebone plate system 10 includes a bone plate 12 and anchor devices 14, 16of the bone plate 12 configured to secure the bone plate 12 to the ribportions 38, 40. The anchor devices 14, 16 include pairs of upper andlower jaws 20, 22 and 24, 26 having teeth 30, 32 configured to clamponto cortical bones 36A, 36B of the rib portions 38, 40. In one form,the bone plate 12 and jaws 20, 22, 24, 26 are formed integrally from aresilient material, such as super elastic nitinol. The resilientproperties of the bone plate 12 bias the jaws 20, 22 and 24, 26 togetheronce the jaws 20, 22 and 24, 26 have been deflected away from each otherand positioned on the cortical bones 36A, 36B. This biasing due to theresilient properties of the bone plate 12 engages the teeth 30, 32 withthe cortical bones 36A, 36B and secures the bone plate 12 to thecortical bones 36A, 36B. The bone plate 12 thereby extends across thecut 39A and secures the cut rib portions 38, 40 together by forming arigid connection between the cortical bones 36A, 36B, which aretypically the strongest sections of the cut rib portions 38, 40. Withreference to FIGS. 10 and 11, the bone plate 12 has a small footprint onan anterior surface 66 of the rib sections 38, 40 which minimizesirritation to surrounding tissues. Further, the bone plate 12 does notcontact or extend across an underside 67 of the rib sections 38, 40which limits interference with the neurovascular bundle 69 thereon.

With reference to FIGS. 4-4B, the bone plate 12 is connected to each ofthe rib portions 38, 40 using a process similar to attaching a binderclip to a stack of papers. More specifically, a user shifts one or bothof the upper and lower jaws 24, 26 to reconfigure the jaws 24, 26 froman undeflected, initial configuration (see FIG. 3) to a deflected, openconfiguration (see FIG. 4) which widens a bone receiving gap 52 betweenthe jaws 24, 26. The bone plate 12 is then advanced in direction 37 sothat the lower jaw 26 travels into an intramedullary canal 39 of the ribsection 40 along an inner surface 41 of the cortical bone 36B and theupper jaw 24 travels outside of the rib section 40 along an outersurface 43 of the cortical bone 36B, as shown in FIG. 4A. In oneapproach, a trocar may be inserted into the intramedullary canal 39 toremove or reposition cancellous bone within the intramedullary canal 39.The bone plate 12 is advanced in direction 37 until an end 45 of thecortical bone 36B abuts supports 74, 76 of the bone plate (see FIG. 1).Next, the one or both deflected jaws 24, 26 are released that permitsthe one or more jaws 24, 26 to shift to a less deflected, clampingconfiguration which narrows the bone receiving gap 52 between the jaws24, 26, as shown in FIG. 4B. This clamps the jaws 24, 26 onto thecortical bone 36B and tightly engages the teeth 32 with the inner andouter surfaces 41, 43 of the cortical bone 36B. In one approach, thejaws 24, 26 are configured to clamp the cortical bone 36B with 60 lbs offorce.

The jaws 20, 22 are fixed to the cortical bone 36A using a processsimilar to the process of fixing the jaws 24, 26 to the cortical bone36B. With reference to FIG. 4B, one or both of the jaws 20, 22 aredeflected away from the other jaw 20, 22 to reconfigure the jaws 20, 22from an undeflected, initial configuration to a deflected, openconfiguration which expands a bone receiving gap 50 between the jaws 20,22. With the jaws 20, 22 in the open configuration, the cortical bone36A of rib section 38 is advanced in direction 51 into thebone-receiving gap 50 so that the lower jaw 22 travels into anintramedullary canal 53 of the rib section 38 and along an inner surface55 of the cortical bone 36A while the upper jaw 24 travels along anouter surface 57 of the rib section 38. The rib section 38 is advancedin direction 51 until an end 59 of the cortical bone 36A abuts thesupports 74, 76. (In one approach, the cortical bone ends 45, 59 arenotched during surgery to receive the supports 74, 76 and minimize thegap between the cortical bone ends 45, 59 caused by the presence of thebone plate 12.) Next, the one or both jaws 20, 22 are released whichpermits the one or more jaws 20, 22 to shift to an intermediate (andless deflected) clamping configuration which narrows the bone receivinggap 50 between the jaws 20, 22. As shown in FIG. 2, this clamps the jaws20, 22 onto the cortical bone 36A and tightly engages the teeth 30 withthe inner and outer surfaces 55, 57 of the cortical bone 36A. In thismanner, the bone plate 12 may be fixed to the cortical bones 36A, 36B tostabilize the rib sections 38, 40.

With reference to FIGS. 1 and 3, the bone plate 12 has a body 70 with abone growth window 72 therein that permits cortical bone growth betweenthe ends 45, 59 of the ribs sections 38, 40 (see FIG. 2). The body 70includes the supports 74, 76 extending between the upper jaws 20, 24 andlower jaws 22, 24. With reference to FIG. 12, the supports 74, 76 are onopposite sides of the window 72 which provides a cortical bone growtharea 80 therebetween. The cortical bone growth area 80 permits thecortical bone 36A, 36B to fuse together through the bone plate window 72which further secures the bone plate 12 to the rib sections 38, 40.Further, the cortical bones 36A, 36B may fuse together post-operativelyalong end surface area 84 of the rib sections 38, 40, as shown in FIG.12. The bone plate 12 thereby maximizes the ability of the corticalbones 36A, 36B to fuse together while obstructing cortical bone growthin only small areas 82, 86 at the supports 74, 76. In one approach, thebone plate 12 obstructs only 20% of the end surface area 84 of thecortical bone sections 36A, 36B and permits the remaining 80% of the endsurface area 84 of the sections 36A, 36B to fuse togetherpost-operatively.

With reference to FIGS. 3 and 4 the bone plate 12 has features thatincrease the ease with which the bone plate 12 may be applied to thecortical bones 36A, 36B of the rib sections 38, 40. The jaws 20, 22 and24, 26 have tips 90, 92, 94, 96 each including a leading end 100configured to engage the end 45 or 59 of the cortical bones 36A, 36B(see FIG. 2) and shift the associated jaw 20, 22, 24, or 26 away fromthe cortical bone 36A, 36B. For example, the end 100 of the jaw 20 has arounded outer surface 102 extending inward toward an inclined surface104. The rounded outer surface 102 contacts the end 59 of the corticalbone 36A and the inclined surface 104 shifts the jaw 20 upward indirection 106 as the cortical bone 36A is advanced in direction 51 intothe gap 50 between the jaws 20, 22 (see FIG. 4B). In this manner, theinclined surface 104 may operate as a cam surface that translates thelinear movement of the cortical bone 36A along the gap 50 into outwarddeflection of the jaw 20. The outward deflection of the jaw 20 widensthe gap 50 and permits the cortical bone 36A to be advanced farther intothe gap 50 toward the supports 74, 76. With reference to FIG. 3, theleading end 100 of the jaw 22 also has an outer curved surface 102 andan inclined surface 104 configured to contact the end 59 of corticalbone 36A and shift the jaw 22 outwardly away from the jaw 20 in a mannersimilar to the leading end 100 of the jaw 20. It will be appreciatedthat one or both of the jaws 20, 22 may be shifted outwardly duringpositioning of the jaws 20, 22 on the cortical bone 36A depending on,for example, the thickness of the cortical bone 36A and/or the approachangle of the jaws 20, 22.

With reference to FIGS. 1 and 3, another feature of the bone plate 12that increase the ease with which the bone plate 12 may be applied tothe cortical bones 36A, 36B are ramp surfaces 112 of the teeth 30. Eachtooth 30 and ramp surface 112 thereof extends from one side 117 (seeFIG. 1) of the bone plate 12 to another side 119 of the bone plate 12with a generally triangular cross-section. With respect to FIG. 4, theramp surface 112 extends along a plane 113 oriented at an acute angle115 relative to the direction 51 in which the cortical bone 36A isadvanced into the bone-receiving gap 50. Each ramp surface 112 isconfigured to engage the cortical bone 36A as the cortical bone end 59is advanced in direction 51 into the bone-receiving gap 50 between thejaws 20, 22. The ramp surface 112 causes the respective tooth 30 andassociated jaw 20 or 22 to shift away from the cortical bone 36A as thecortical bone 36A engages and travels along the ramp surface 112. Thus,one or both of the jaws 20, 22 are shifted apart due to engagement ofthe inclined surfaces 104 and ramp surfaces 112 with the cortical bone36 which expands the gap 50 and permits the cortical bone 36A to travelfarther into the gap 50.

Once the cortical bone end 59 has been advanced into abutting contactwith the supports 74, 7, the resilient properties of the bone plate 12bias the one or both previously—shifted jaws 20, 22 toward the clampingconfiguration which clamps the jaws 20, 22 against the cortical bone36A, as shown in FIG. 2. This drives points 120 of the teeth 30 (seeFIG. 3) into the internal and external surfaces 55, 57 of the corticalbone 36A and fixes the jaws 20, 22 to the cortical bone 36A, as shown inFIG. 2. The teeth 30 each also have a stop surface 122 orientedtransverse to a withdrawal direction 110 for the rib section 38, asshown in FIG. 3. As the teeth points 120 dig into the interior andexterior surfaces 55, 57 of the cortical bone 36A, the stop surface 122engage the cortical bone 36A near the points 120 and resist movement ofthe cortical bone 36A in direction 110 outward from the bone—receivinggap 50 between the jaws 20, 22. Thus, whereas the ramp surface 112 ofeach tooth 30 facilitates advancing of the cortical bone 36A indirection 51 between the jaws 20, 22 (see FIG. 4B), the point 120 andstop surface 122 bite into the cortical bone 36A and restrict movementof the cortical bone 36A in withdrawal direction 110 (see FIG. 2) oncethe one or more jaws 20, 22 have resiliently shifted toward the clampingconfiguration.

Further, the jaws 24, 26 have teeth 32 and tips 94, 96 with shapessimilar to the jaws 20, 22 and which function similarly to facilitateconnecting of the jaws 24, 26 to the cortical bone 36B. However, withreference to FIGS. 2 and 4A, the teeth 32 are configured and arranged topermit the cortical bone 36B to be advanced in direction 107 (which isopposite to direction 51, see FIG. 4B) between the jaws 24, 26 whilefixing the jaws 24, 26 to the cortical bone 36A and restricting movementof the cortical bone 36A in withdrawal direction 37 (which is oppositeto direction 110) outward from between the jaws 24, 26. The oppositeretention forces produced by the jaws 20, 22 and 24, 26 once fixed tothe cortical bones 36A, 36B resists the rib sections 38, 40 from movingapart post-operatively, such as movement due to the patient's breathing.

It will be appreciated that the teeth 30, 32 may take a variety of formsand may be adapted for particular applications. For example, the teeth30, 32 may include rows of smaller, spaced teeth rather than a singletooth extending between the sides 117, 119 of the bone plate 12. Asanother example, the teeth 30, 32 may have hook-shaped cross sectionsrather than the generally triangular shape shown in FIG. 2. As yetanother example, one or more of the teeth 30, 32 can have differentcross-sections and/or interruptions.

The jaws 20, 22, 24 and 26 of the bone plate 12 are configured toaccommodate a large variety of rib sizes and shapes. With reference toFIG. 3, the jaws 24, 26 decrease in thickness as the jaws 24, 26 extendfrom the supports 74, 76 toward the tips 94, 96 thereof. The jaws 24, 26include bases 140, 142 near the supports 74, 76 and thicknesses 144, 146of the jaws 24, 26 at the bases 140, 142. The thickness of each of thejaws 24, 26 gradually decreases as the jaw 24, 26 extend away from thebases 140, 142. The gradual decrease in thickness of the jaws 24, 26 asthe jaws 24, 26 extend away from the bases 140, 142 permits the jaws 24,26 to clamp both relatively thick and relatively thin cortical bones 36Bwithout exceeding a predetermined amount of the deflection of one orboth of the jaws 24, 26 and corresponding stress at the base 140.

More specifically and with reference to FIG. 4, for a thicker corticalbone 36B, teeth 160A-160C of the jaw 26 may engage the interior surface41 of the cortical bone 36B, teeth 162A-162C of the jaw 24 may engagethe exterior surface 43 of the cortical bone 36B, and teeth 162D-162Hmay be spaced from the exterior surface 43 and not engaged with thecortical bone 36B. The teeth 162D-162H would be spaced from the exteriorsurface 43 in this example because the thicker cortical bone 36B shiftsthe base 140 of the jaw 24 away from the jaw 26 due to the engagement ofthe teeth 162A-162C with the exterior surface. By contrast, for athinner cortical bone 36B, the teeth 160A-160C of the jaw 26 may engagethe interior surface 41 of the cortical bone 36B, the teeth 162A-162C ofthe jaw 26 may be spaced from the exterior surface 43 of the corticalbone 36A, and the teeth 162D-162H may engage the exterior surface 43 ofthe cortical bone 36B. Because the cortical bone 36B is thinner, thecortical bone 36B does not shift the base 140 of the jaw 24 away fromthe jaw 24 but instead shifts the tip 94 due to the engagement of theteeth 162D-162H. The engagement of the jaws 24, 26 with the thinnercortical bone 36B is similar to the configuration shown in FIG. 2, whereteeth 32 of the jaw 24 near the base 140 (see FIG. 3) are spaced fromthe cortical bone 36B whereas the teeth 32 of the jaw 24 near the tip 94(see FIG. 3) are engaged with the cortical bone 36B. It will beappreciated that the jaws 20, 22 and 22, 24 may thereby clamp and fixthe bone plate 12 to cortical bones 36A, 36B having varying thicknessesby engaging the bones 36A, 36B with different sections of the clampingteeth 30, 32 depending on the thickness of the bones 36A, 36B. Thedecreasing thickness of the jaws 24, 26 provides this flexibility bypermitting the teeth 32 near the tips 94, 96 to be spaced from orotherwise not tightly engaged with thicker cortical bone 36B. Bycontrast, if the jaws 24, 26 have uniform thicknesses along theirlength, all of the teeth 32 may engage the thicker cortical bone 36Bwhich could require the jaws 24, 26 to be deflected apart farther andcould increase the stress at the bases 140, 142 of the jaws 24, 26.

With reference to FIGS. 5 and 6, an inserter tool 200 is shown forholding the bone plate 12 and reconfiguring the jaws 20, 22, 24, 26 tothe open configuration by deflecting the jaws 20, 24 away from the jaws22, 26. The inserter tool 200 includes a pair of levers 202, 204 eachhaving a handle 206 and a plate engaging portion 208. The plate engagingportion 208 includes a foot 210 (see FIG. 6) having a heel 212 with afulcrum 214 and a toe 216 having a stud 218. The stud 218 has a head 220and a shaft 222 sized to fit within openings 223 of claw 225, 227 of theupper jaws 20, 24 (see FIGS. 1 and 11). The stud shaft 222 extends alongan axis 231 which is oriented at an angle 231A to a longitudinal axis231B of the lever handle 206.

To connect the lever 202 to the jaw 20, the lever 202 is manipulated toalign the stud 218 with the opening 223 of the claw 225. The stud 218 isthen moved in direction 230 (see FIG. 11) to advance the stud shaft 222into the claw opening 223 and engage the stud shaft 222 with a surface232 extending about the claw opening 223. This positions the stud head220 below the upper jaw 20. Next, the fulcrum 214 is positioned againsta central, upper surface 234 of the jaw 20 near the supports 74, 76 (seeFIG. 5). With the stud head 220 engaged with the underside of the jaw 20and the fulcrum 214 abutting the jaw central, upper surface 234,pivoting the lever 202 in direction 294 (see FIG. 6) causes the stud 218to pull the upper jaw 20 upward and shift the upper jaw 20 away from thelower jaw 22. In this manner, the levers 202, 204 may each be connectedto the respective claws 225, 227 of the jaws 20, 24 (see FIGS. 1 and 11)and pivoted together in directions 294, 296 (see FIG. 5) tosubstantially simultaneously pull both of the jaws 20, 24 away from thejaws 22, 26 and reconfigure the jaws 20, 22, 24, 26 to the openconfiguration. As shown in FIGS. 8 and 9, the levers 202, 204 each havea flat surface 297 that abuts the flat surface 297 of the other lever202, 204 and restricts opening of the jaws 20, 24 beyond a predeterminedposition.

With respect to FIG. 5, the inserter tool 200 also includes a sleeve 250for maintaining the levers 202, 204 in the pivoted position where theflat surfaces 297 abut and the jaws 20, 24 have been pulled upward. Morespecifically, once the levers 202, 204 have been pivoted in directions294, 296 to open the jaws 20, 24, the sleeve 250 is manipulated toposition a throughbore 252 of the sleeve 250 into alignment with ends254, 256 of the levers 202, 204 (see FIG. 5). With reference to FIG. 9,the sleeve 250 is then advanced in direction 258 over the levers 202,204 so that the ends 254, 256 extend proximally from the sleeve 250. Dueto the resilient properties of the bone plate 12, the jaws 20, 24 arenaturally biased toward the jaws 22, 26 in response to using the levers202, 204 to deflect the upper jaws 20, 24, as discussed above. Thisbiasing force urges the levers 202, 204 engaged with the jaws 20, 24apart in directions 260, 262, as shown in FIG. 9. The sleeve 250 appliesa reactive compressive force in directions 270, 272 inwardly against thelevers 202, 204 to resist separation of the levers 202, 204.

With respect to FIG. 5, a tray 280 is shown having a compartment 282configured to receive the bone plate 12, the levers 202, 204 connectedto the bone plate 12, and the sleeve 250. The tray 280 maintains thebone plate 12 and levers 202, 204 in a preassembled configuration andpermits rapid, one-handed removal of the bone plate 12 and levers 202,204 preassembled thereto in an operating room environment, as will bediscussed in greater detail below. Further, the tray 280 may be utilizedin conjunction with a box, shrinkwrap, or other packaging and permitssecure storage and transport of the bone plate 12 and inserter tool 200.

The compartment 282 includes a recess 284 and side walls 286, 288extending therealong that generally bow outwardly away from a sidewall290 that supports the bone plate 12, as shown in FIG. 5. The sidewalls286, 288 are arranged to extend at an angle 297 relative to a centerline 294 of the tray 280 and support the handles 206 in a partiallypivoted position (which produces a partial deflection of the jaws 20, 24away from the jaws 22, 26). More specifically, to insert the levers 202,204 and the bone plate 12 into the tray 280, the levers 202, 204 arefirst connected to the bone plate 12 using the studs 218 and bone plateclaws 225, 227 as discussed above. Next, the levers 202, 204 are pivotedtoward each other in directions 294, 296 (see FIG. 5), which deflectsthe jaws 20, 24 away from the jaws 22, 26, and the connected levers 202,204 and bone plate 12 are inserted into the compartment 282. The handles206 of the levers 202, 204 are released and the resilient properties ofthe bone plate 12 biases the deflected jaws 20, 24 back toward the jaws22, 26 which in turn biases the levers 202, 204 apart in directions 300,302 as shown in FIG. 5. The tray sidewalls 286, 288 resist the biasforce applied in directions 300, 302 from the levers 202, 204. The biasforce of the levers 202, 204 outwardly in directions 300, 302 creates apreload on the assembly of the levers 202, 204 and the bone plate 12 inthe tray compartment 282 which firmly engages the levers 202, 204 andbone plate 12 connected thereto within the compartment 282 of the tray280.

The tray 280 may also have portions 304, 306 of the recess 284 atproximal ends of the levers 202, 204 in order to permit a user towithdraw the levers 202, 204 and connected bone plate 12 from the tray280 in a one-handed operation. For example, a user may insert the thumbof his right hand into recess portion 304, wrap his thumb around thehandle 206 of the lever 202, insert the index and middle finger of hisright hand into the recess portion 306, wrap his index and middlefingers around the handle 206 of the lever 204, and then make a firstwith his right hand. This motion moves the handles 206 outward frombeneath overhangs 286A, 288A of the sidewalls 286, 288, pivots thelevers 202, 204 toward each other in directions 294, 296, and shifts thejaws 20, 24 away from the jaws 22, 24. The levers 202, 204 and boneplate 12 are connected thereto (with jaws 20, 22, 24, 26 in the openconfiguration) may then be withdrawn from the tray 280.

The compartment 282 may further include a recess 308 below the sleeve250 that permits the user to withdraw the sleeve 250 with one hand afterremoving the levers 202, 204 and connected bone plate 12 with the otherhand. Continuing with the example above, after the user has withdrawnthe levers 202, 204 and connected bone plate 12 with his right hand, theuser can insert the thumb of his left hand into the recess 308 on oneside of the sleeve 250, insert the index through pinky fingers of hisleft hand into the recess 308 on the other side of the sleeve 250, graspthe sleeve 250 with his left hand, then remove the sleeve 250 from thetray 280.

In this manner, the user may insert a first hand into the compartment282 and grasp the handles 206 of the levers 202, 204, compress thehandles 206 toward one another, withdraw the assembled levers 202, 204and bone plate 12 from the compartment 282 with the first hand, and theninsert his other hand into the compartment 282 and remove the sleeve 250in one fluid movement for each hand. After removing the levers 202, 204,bone plate 12, and sleeve 250 from the tray 280, the user may then pivotthe levers 202, 204 into the abutting configuration of FIG. 9 and thenslide the sleeve 250 downward over the lever ends 254, 256 in direction258 (see FIG. 9). The sleeve 250 maintains the levers 202, 204 in theabutting orientation, keeps the levers 202, 204 connected to the jaws20, 22, and maintains the jaws 20, 22, 24, 26 in the open configuration.In this manner, the sleeve 250, levers 202, 204, and bone plate 12 areeasy to assemble and handle within the operating room.

With reference to FIG. 9, the inserter tool 200 may be used to positionthe bone plate 12 on the rib sections 38, 40. More specifically, withthe sleeve 250 maintaining the levers 202, 204 in the abuttingconfiguration, the jaw 20 is maintained deflected away from the lowerjaw 22 which permits the jaws 20, 22 to be advanced in direction 319 sothat the cortical bone 36A advances into the gap 50 between the jaws 20,22 (this operation is similar to the movement of the jaws 24, 26discussed above with respect to FIG. 4A). The sleeve 250 maintaining thelevers 202, 204 in the abutting configuration also maintains the jaw 24deflected away from the jaw 26. This permits the rib cortical bone 36Bto be advanced in direction 320 into the bone receiving gap 52 betweenthe jaws 24, 26 (this operation is similar to the movement of the jaws20, 22 discussed above with respect to FIG. 4B).

With the cortical bones 36A, 36B in the desired positions between thejaws 20, 22 and 24, 26, the sleeve 250 is then slid off of the levers202, 204 in direction 322, as shown in FIG. 9. This permits the levers202, 204 to pivot away from one another in directions 260, 262. Theresilient properties of the bone plate 12 bias the upper jaws 20, 24back toward the lower jaws 22, 26 and reconfigure the jaws 20, 22, 24,26 to the clamping configuration. The jaws 20, 22, 24, 26 clamp thecortical bones 36A, 36B therebetween and fix the bone plate 12 to therib sections 38, 40. The levers 202, 204 may then be disconnected fromthe bone plate 12 by moving the studs 218 in directions 322, 324 (seeFIG. 11) out of engagement with the claws 225, 227 of the bone plateupper jaws 20, 24.

The bone plate 12 may be made of a variety of different materials. Inone approach, the bone plate 12 is made of super elastic nitinol thatresiliently permits deflection of one or both of the jaws 20, 22 and 24,26 to reconfigure the jaws 20, 22, 24, 26 to the open configuration. Inanother approach, the bone plate 12 may be made of a shape-memoryNitinol where the jaws 20, 22, 24, 26 shift to an open configurationwhen the bone plate 12 is chilled, such as by submerging the bone plate12 in saline, to a temperature below the internal temperature of thepatient. With the bone plate 12 chilled and the jaws 20, 22, 24, 26 inthe open configuration, the jaws 20, 22, 24, 26 may not be biased towardeach other (due to the crystalline structure of the chilled nitinol boneplate 12). However, positioning the bone plate 12 on the rib sections38, 40 within the patient raises the temperature of the bone plate 12and reconfigures the jaws 20, 22, 24, 26 to a clamping configuration.With the bone plate 12 at this elevated temperature, the shape-memoryproperties of the Nitinol bias one or more of the jaws 20, 22 and 24, 26together and causes the jaws 20, 22, 24, 26 to clamp the cortical bones36A, 36B. In other approaches, the bone plate 12 may be made ofpolyether ether ketone (PEEK), titanium, or other biocompatibleplastics, metals, or alloys.

With reference to FIGS. 13 and 14, another bone plate system 400 isshown for securing bones such as sections 402, 404 of a broken rib 405.The bone plate system 400 is similar in many respects to the bone platesystem 10 discussed above such that differences between the two will behighlighted. One difference is that the bone plate system 400 isconfigured to fit entirely with sections 406, 408 of an intramedullarycanal 409 of the rib 405, whereas the jaws 20, 24 of the bone plate 12are disposed outside of the rib 39. More specifically, the bone platesystem 400 includes a bone plate 410 having anchor devices 412, 414 forfixing the bone plate 410 to the rib sections 402, 404. The bone plate410 has a body 416 connecting the anchor devices 412, 414 and oppositeleading ends 420, 421 configured to be advanced into the intramedullarycanal sections 406, 408. The anchor devices 412, 414 each include a pairof resilient arms 422, 424 extending away from the leading ends 420,421. The arms 422, 424 have teeth 426 along outer surfaces 428, 429 ofthe arms 422, 424. The bone plate 410 may be made of a resilientmaterial, such as super elastic ninitol, such that the arms 422, 424 arebiased outwardly into an expanded configuration as shown in FIG. 13.

The leading ends 420, 421 include inclined surfaces 430, 432 configuredto cam against internal surfaces 444, 446 of the intramedullary canalsections 406, 408 and deflect the arms 422, 424 inward. In use, theleading end 420 is advanced into the intramedullary canal section 406 indirection 436 and the leading end 421 is advanced in direction 438 intothe intramedullary canal 408. Inserting the ends 420, 421 into the canalsections 406, 408 deflects the arms 422, 424 toward one another due tothe camming engagement of the surfaces 430, 432 against the internalsurfaces 444, 446 of the intramedullary canal sections 406, 408. The ribsections 402, 404 are brought together in directions 447, 449 to fullyadvance the bone plate leading ends 420, 421 into the intramedullarycanal sections 406, 408. The resilient properties of the bone plate 410bias the deflected arms 422, 424 apart in directions 440, 442 whichdrives the teeth 426 of the arms 422, 424 into the interior surfaces 444and 446 of the intramedullary canal sections 406, 408. In this manner,the bone plate 410 is fixed to the rib sections 402, 404 while beingdisposed entirely within the rib sections 402, 404.

With reference to FIGS. 15 and 16, another bone plate system 500 isprovided that is similar in many respects to the bone plate systems 10,400 discussed above such that differences between the bone plate system500 and bone plate systems 10, 400 will be highlighted. One differenceis that the bone plate system 500 includes a bone plate 502 having abody 504 with an upper portion 506 and a lower portion 508 connected bya support 510. The bone plate 502 has anchor devices 512, 514 for fixingthe bone plate 502 to sections 516, 518 of a cut rib 519. The anchordevices 512, 514 include clamp screws 520, 522 engaged with threadedopenings 524, 526 of the upper portion 506.

With reference to FIG. 16, the bone plate 502 is connected to the ribsections 516, 518 by inserting the bone plate lower portion 508 intosections 530, 532 of an intramedullary canal 533 of the rib 519. Theclamp screws 520, 522 may be shifted to a clamping configuration whichshifts engaging members 534, 536 of the clamp screws 520, 522 against anexternal surface 540 of the rib sections 516, 518. Shifting the clampscrews 520, 522 to the locked position draws the bone plate lowerportion 508 against an interior surface 542 of the ribs 516, 518.Continued shifting of the clamp screws 520, 522 toward the lockedposition thereof tightly clamps cortical bones 544, 546 of the ribsections 516, 518 between the engaging members 534, 536 and the platelower portion 508. The anchor devices 512, 514 may further include alock device, such as a pins 550, 552 inserted into openings 554 in theclamp screws 520, 522 and the plate upper portion 506 after the clampscrews 520, 522 have been driven to the locked position. The pins 550,552 restrict movement of the clamp screws 520, 522 away from the lockedpositions thereof and corresponding disengagement of the clamp members534, 536 from the cortical bones 544, 546.

With reference to FIGS. 17 and 18, a bone plate system 600 is shown thatis similar in many respects to the bone plate system 10 discussed abovesuch that differences between the two will be highlighted. Onedifference is that the bone plate system 600 includes a bone plate 602having anchor devices 604, 606 for fixing the bone plate 602 to boneportions. The anchor devices 604, 606 include jaws 610, 612 and 611, 613and expansion devices 614 for shifting the jaws 602, 604 betweenclamping and open configurations. With reference to jaws 610, 612, thedevice 614 includes a bolt 620 having a threaded shank 626 engaged withthreads 622 of an opening 624 in the upper jaw 610. The bolt shank 626has a distal end 627 that engages a seat 628 of the lower jaw 612.Turning the bolt 620 in a tightening direction engages the shank distalend 627 against the seat 628. The jaw 612 is configured to be more rigidthan the jaw 610 such that continued turning of the bolt 620 threadinglyadvances the jaw 610 away from the jaw 612 until the jaws 610, 612 reachan open configuration, as shown in FIG. 18.

With the jaws 610, 612 in the open configuration, the jaws 610, 612 maybe advanced into position on bone portions, such as cortical bones 36A,36B (see FIG. 2). Then, the bolt 620 may be turned in a looseningdirection that permits the jaw 610 to return to the clampingconfiguration of FIG. 17 due to the resilient properties of the boneplate 602. In another approach, the bone plate 602 is generally rigid.Rather than rely upon the resilient properties of the bone plate 602 toreturn the jaw 610 to the clamping configuration, the shank distal end627 is rotatably connected to the jaw 612, such as by a yoke 630.Turning the bolt 620 in the loosening direction thereby creates tensionin the bolt 620 that draws the jaw 610 toward the jaw 612 andreconfigures the jaws 610, 612 to the clamping configuration.

With reference to FIGS. 19 and 20, another bone plate system 700 isshown that is similar in many respects to the bone plate system 10discussed above such that difference between the bone plate systems 10,700 will be highlighted. One difference between the bone plate systems10, 700 is that the bone plate system 700 includes a bone plate 702having anchor devices 704, 706 configured to grip only outer surfaces ofsections 708, 710 of a rib 711 (see FIG. 19A) rather than the ribinterior surfaces 41, 55 and exterior surfaces 43, 57 as in the boneplate system 10 (see FIG. 2).

More specifically, the anchor devices 704, 706 include front jaws 712,713 and rear jaws 714, 715 configured to engage, respectively, theanterior and posterior regions 716, 718 of the rib sections 708, 710 asshown in the bottom plan view of FIG. 19A. In this approach, the jaws712, 713, 714, and 715 are positioned away from a neurovascular bundle720 running along an underside 722 of the rib section 708, 710.

With reference to FIGS. 19 and 20, the bone plate 702 includes supports730, 732 sized to extend across the intramedullary canals of the ribsections 708, 710. Further, the bone plate 702 has a bone growth window734 that permits cortical bone to grow between the rib sections 708,710.

With reference to FIGS. 21 and 22, another bone plate system 800 isshown that is substantially similar to the bone plate system 700discussed above. One difference is that the bone plate system 800includes a bone plate 802 having anchor devices 804, 806 and a body 808connecting the anchor devices 804, 806. In one form, the anchor devices804, 806 include jaws 810, 812 for engaging outer surfaces of the ribsections 708, 710 in a manner similar to the jaws 712, 714, However, theanchor devices 804, 806 further include a brace 820 configured to extendinto and along the intramedullary canals of the rib sections 708, 710.The brace 820 may have an outer surface 822 configured to engageinterior surfaces of the intramedullary canals of the ribs 708, 710 andprovide an additional anchor point for each of the anchor devices 804,806. In this manner, the anchor devices 804, 806 may engage outersurfaces of the anterior and posterior regions 716, 718 of the ribsections 708, 710 (see FIG. 19A) via the jaws 810, 812 as well asinterior surfaces of the intramedullary canals of the rib sections 708,710 via the brace 820.

With reference to FIG. 22, the bone plate 802 includes a bone growthwindow 830 extending through the bone plate 802 and between the guides820 of the anchor devices 804, 806. The bone growth window 830 permitscortical bone growth across the bone plate 802 despite the engagement ofthe brace 820 with the inner surfaces of the intramedullary canal of theribs 708, 710.

With reference to FIGS. 23-25, another bone plate system 900 is shown.The bone plate 900 is similar in many respects to the bone plate system400 discussed above such that the differences between the two will behighlighted. One difference is that the bone plate system 900 includes abone plate 902 having anchor devices 904, 906 and a body 908 connectingthe anchor devices 904, 906. The bone plate 902 has a pair of narrowedleading ends 910, 911 that are narrower relative to a wider centralportion 912 of the body 908 (see FIG. 25). With reference to FIG. 25,the leading ends 910, 911 include tapered outer surfaces 914, 916 whichconverge and provide the narrow profile of the leading ends 910, 911.The narrower leading ends 910, 911 function as wedge to separate andmove the cancellous bone within the intramedullary canals 406A, 406B ofthe rib sections 402, 404.

Another difference between the bone plate 902 and the bone plate 402 isthat the bone plate 902 includes barbs 920, 922 at the wider centerportion 912. The barbs 920, 922 are configured to engage the corticalbone of the rib sections 402, 404 and prevent the bone plate 902 frombeing advanced beyond a predetermined position in the intramedullarycanals 406A, 406B.

With reference to FIGS. 26-29, another bone plate system 1000 is shown.The bone plate system 1000 includes a bone plate 1002 having a pair ofanchor devices 1004, 1006 configured to fix the bone plate 1002 to cutrib sections. Like the bone plate 702, the bone plate 1002 is configuredto engage outer surfaces of rib sections 1024, 1026 (see FIG. 28)without contacting a neurovascular bundle running along the underside ofthe rib sections 1024, 1026. However, the bone plate 1002 is disposedentirely around the rib sections 1024, 1026 rather than extending acrossthe intramedullary canal (the support 730 of the bone plate 702 extendsacross the intramedullary canals of rib sections 708, 710).

With reference to FIG. 27, the anchor devices 1004, 1006 each include anupper jaw 1008 and a lower jaw 1010 common to both anchor devices 1004,1006. The upper jaws 1008 each include a claw 1012 with a correspondingopening 1014 for engaging a tool which may be used to pry apart the jaws1008, 1010 in a manner similar to the inserter tool 200 and bone plate12 discussed above.

With reference to FIG. 28, the jaws 1008, 1010 have a bone-receiving gap1020 therebetween. In use, one or both of the jaws 1008, 1010 is shiftedoutward in directions 1016, 1018 to shift the jaws 1008, 1010 to an openconfiguration. Next, the bone plate 1002 is advanced downward indirection 1022 onto the rib sections 1024, 1026 and the one or both jaws1008, 1010 are released. The resilient properties of the bone plate 1002bias the jaws 1008, 1010 together which clamps the jaws 1008, 1010against the rib sections 1024, 1026. With reference to FIG. 27, the boneplate 1002 includes raised, pointed beads 1030 extending along aninterior surface 1032 of the bone plate 1002. The pointed beads 1030bite into the outer surfaces of the ribs 1024, 1026 and restrictmovement of the bone plate 1002 relative to the rib sections 1024, 1026.

With reference to FIG. 29, the bone plate 1002 includes a cutout 1040between the jaws 1008 that enhances the flexibility of the jaws 1008.The jaws 1008 may be compressed in different amounts depending onpatient geometry. The bone plate 1002 thereby provides greaterflexibility than some bone plates which require uniform deformation ofthe plate along the entire length of the plate.

With reference to FIG. 29A, another bone plate system 1050 is shown thatis similar in many respects to the bone plate system 1000 such thatdifferences between the two will be highlighted. One difference betweenthe bone plate systems 1000, 1050 is that the bone plate system 1050includes a bone plate 1052 having two jaws 1054, 1056 and a hinge 1058pivotally connecting the jaws 1054, 1056. Rather than utilize theresilient properties of the bone plate 1052 to cause the jaws 1054, 1056to clamp a cut rib 1060, the bone plate 1052 has a locking device 1062configured to hold the jaws 1054, 1056 in a clamping configuration aboutthe cut rib 1060 once the jaws 1054, 1056 have been compressed indirections 1061, 1063 against the cut rib 1060. In one form, the lockingdevice 1062 includes a protrusion 1064 of the jaw 1056 that snaps into arecess 1066 of the jaw 1054 once the jaws 1054, 1056 have been pivotedtoward each other about the hinge 1058 to a predetermined clampingconfiguration. The engagement of the protrusion 1064 and recess 1066restricts relative pivoting movement of the jaws 1054, 1056 about thehinge 1058 and maintains the jaws 1054, 1056 in the clampingconfiguration thereof. With reference to FIG. 29A, it will beappreciated that jaws 1054, 1056 are configured to avoid interferencewith a neurovascular bundle 1070 running along an underside of the cutrib 1060.

With reference to FIGS. 30-41, another bone plate system 1100 is shown.The bone plate system 1100 is especially well suited for stabilizingbone portions, such as portions 1104, 1106 of clavicle bone separated bya break or cut 1102. The bone plate system 1100 includes a bone plate1110 having bone screws 1112, 1113, 1142, 1144 that provide primaryfixation system for securing the bone plate 1110 to the bone portions1104, 1106 and surgical cables 1114, 116 that provide a secondaryfixation system for securing the bone plate 1110 to the bone portions1104, 1106.

The bone plate 1110 includes locking mechanisms 1120, 1122 and tortuouspathways 1124, 1126 for securing the cables 1114, 1116 to the bone plate1110. The locking mechanisms 1120, 1122 and tortuous pathways 1124, 1126are particularly well suited to secure polymer surgical cables 1114,1116 to the bone plate 1110. Polymer surgical cables 1114, 1116 may bedesirable in some applications because the cables 1114, 1116 tend toflatten out against the bones 1106, 1104 rather than biting into thebone portions 1104, 1106. Further, ends of the polymer cables 1114, 1116generally do not fray after cutting which may occur with metal surgicalcables. With continued reference to FIG. 30, the locking mechanisms1120, 1122 include clamp bodies 1130, 1132 that are drawn toward thebone plate 1110 against end portions 1134, 1136, 1138, 1140 of thecables 114, 116 by driving the bone screws 1142, 1144 into throughbores1150, 1152 of the bone plate 1110.

With reference to FIGS. 31-33, the bone plate 1112 is shown with thebone screw 1144 and the cable 1114 removed. The bone plate 1112 has apair of lateral inlet through openings 1160A, 1162A through which endportions 1134, 1136 of the cable 1114 are advanced in directions 1164,1166, as discussed in greater detail below. The bone plate 1112 also haslateral outlet through openings 1170A, 1172A through which the cable endportions 1134, 1136 are advanced outwardly therefrom in directions 1174,1176.

With reference to FIG. 32, the bone plate 1112 has a seat 1180B thatsupports a loop 1182B of the cable 1116. The clamp body 1132 has an arm1190 that captures the cable loop 1182B against the seat 1180B when thebone screw 1142 is driven into the throughbore 1150 and clamps the clampbody 1132 against the cable end portions 1138, 1140.

With reference to FIG. 38, the bone plate 1112 has recess 1200A, 1200Bsized to receive the clamp bodies 1130, 1132 and grooves 1202A, 1204Aand 1202B, 1204B configured to receive the end portions 1134, 1136 ofthe cable 1114 and end portions 1138, 1140 of the cable 1116.

With reference to FIGS. 39-41, the clamp body 1132 has a body portion1135 with a clamp body section 1137 of the throughbore 1152 and clampingmembers 1139, 1141 extending laterally outwardly from the body portion1135. The clamping members 1139, 1141 form a step profile of the clampbody 1132, as shown in FIG. 40. Further, the clamping members 1139, 1141have lower surfaces 1143, 1145 that rest upon the cable end portions1138, 1140 and clamp the cable end portions 1138, 1140 between the clampbody 1132 and the bone plate 1110.

With reference to FIGS. 42-46, a method of securing the bone platesystem 1100 to the bone portions 1104, 1106 is shown. Initially, thebone plate 1110 is positioned against the bone portions 1104, 1106 andscrews 1112, 1113 are driven into the respective throughbores to securethe bone plate 1110 to the bone portions 1104, 1106. In anotherapproach, the bone screws 1112, 1113 may be applied after the cables1114, 1116 have been used to secure the plate 1110 to the bone portions1104, 1106.

With reference to FIG. 42, the end portions 1134, 1140 of the cables1114, 1116 are advanced through the inlet openings 1162B in direction1250 until the end portions 1134, 1140 extend outward from a lateralside of the bone plate 1110. In another approach, the cables 1114, 1116may be preassembled to the bone plate 1110 that the end portions 1134,1140 are already extending laterally from the bone plate 1110 as thebone plate system 1100 is shipped from the manufacturing facility. Next,the end portions 1136, 1138 are looped behind the bone portions 1104,1106 in directions 1252, 1254 which moves the end portions 1136, 1138from one side of the bone plate 1110 to the other.

With reference to FIG. 43, the cable end portion 1138 is then looped indirection 1260 over the seat 1180B of the bone plate 1110 to form theloop 1182B before the end portion 1138 is advanced in direction 1262behind the bone portion 1104 back toward the position of the end portion1138 shown in FIG. 42. The cable end portion 1136 is then looped aroundthe seat 1180A in direction 1266 to form loop 1182A before the endportion 1136 is advanced behind the bone portion 1106 back to the otherside of the bone plate 1110 in direction 1268, as shown in FIG. 43.

With reference to FIG. 44, the cable end portions 1136, 1138 are thenadvanced in directions 1270, 1272 into and along the inlet lateralthrough openings 1162A, 1160B (see FIG. 33). With reference to FIG. 45,the cable end portions 1134, 1136, 1138, 1140 are all extending outwardfrom the bone plate 1110 and may be pulled in directions 1280 orotherwise adjusted to remove slack from the cables 1114, 1116. Oncesubstantially all the slack has been removed from the cables 1114, 1116,the end portions 1134, 1136 are folded inward in directions 1182, 1184and positioned along the grooves 1202A, 1204A, and the cable endportions 1138, 1140 are also folded inward in directions 1186, 1188 toposition the end portions 1138, 1140 in the grooves 1202B, 1202B

With reference to FIG. 46, the clamp body 1130 is positioned in therecess 1200 a to position the clamp surfaces 1143A, 1145A of the clampbody 1130 (see FIG. 33) onto the cable end portions 1134, 1136. Thescrew 1144 may be partially driven into the throughbore 1152 in order totemporarily restrain the clamp body 1130 on the bone plate 1110. Thecable ends 1134, 1136 may then be pulled in direction 1300 to applytension to the cable 1114 and draw any remaining slack outwardtherefrom. The screw 1144 may then be fully driven further into thethroughbore 1152. This draws the clamp body 1130 and clamp surfaces1143A, 1145A thereof firmly against the cable end portions 1134, 1136and clamps the cable end portions 1134, 1136 between the clamp body 1130and the bone plate 1110. In this manner, the cable 1114 is fixed to thebone plate 1110 secures the bone plate 1110 to the bone portion 1106. Asimilar process is repeated with the clamp body 1132 in order to tensionthe cable 1116 and clamp the cable end portions 1138, 1140 between theclamp body 1132 and the bone plate 1110.

While there have been illustrated and described particular embodimentsof the present invention, it will be appreciated that numerous changesand modifications will occur to those skilled in the art, and it isintended in the appended claims to cover all those changes andmodifications which fall within the true spirit and scope of the presentinvention.

What is claimed is:
 1. A bone plate for securing a plurality of adjacentbone portions with respect to one another, the bone plate comprising: afirst pair of opposing upper and lower jaws forming a first gaptherebetween for receiving one of the adjacent bone portions; a secondpair of opposing upper and lower jaws forming a second gap therebetweenfor receiving the other adjacent bone portion; a central connectingportion that connects the first pair and the second pair of jaws withthe first pair of jaws extending away from the central connectingportion and the second pair of jaws extending away from the centralconnecting portion in an opposite direction to the first pair of jaws;and at least one of the opposing upper and lower jaws of each pair ofjaws being resiliently flexible and in an unbiased, unexpandedconfiguration, the respective gaps each have a first size, and in adeflected, expanded configuration, the respective gaps each have asecond size larger than the first size for receiving the respectiveadjacent bone portion between the opposing upper and lower jaws tosecure the adjacent bone portion within the respective gap.
 2. The boneplate according to claim 1, wherein the central connecting portionincludes a central opening between the first and second jaw pairs forpromoting fusion between the secured adjacent bone portions.
 3. The boneplate according to claim 2, wherein the central connection portion hasfirst and second supports between which the central opening extendstransversely between the upper and lower jaws of the first and secondjaw pairs.
 4. The bone plate according to claim 2, wherein the upper andlower jaws of each jaw pair extend along a longitudinal axis, and thecentral opening extends along a central axis which is generally parallelto the longitudinal axis.
 5. The bone plate according to claim 1,wherein the upper and lower jaws of each jaw pair comprise inner facingsurfaces and at least one of the inner facing surfaces of each jaw paircomprises one or more protrusions for fixedly engaging with therespective adjacent bone portion with the adjacent bone portion disposedin the respective one of the first or second gaps.
 6. The bone plateaccording to claim 5, wherein the one or more protrusions comprise teethsized and configured to fixedly engage the respective adjacent boneportion to resist expulsion thereof from the respective one of the firstor second gaps.
 7. The bone plate according to claim 1, wherein each ofthe upper and lower jaws of each jaw pair have tips located distallywith respect to the central connecting portion and the upper and lowerjaws of each jaw pair are oriented such that the upper and lower jaws ofeach jaw pair are closer together near the tips than near the centralconnecting portion when the jaw pairs are in the unexpandedconfiguration.
 8. The bone plate according to claim 7, wherein at leastone of the upper and lower jaw tips of each jaw pair includes a toolengagement portion for engaging with a mating tool for shifting the onejaw between the unexpanded and expanded configurations.
 9. The boneplate according to claim 1, wherein the upper and lower jaws of each jawpair and the first and second gaps therebetween are sized and configuredsuch that when each lower jaw is inserted within the intramedullarycanal of the respective adjacent bone portion, a portion of the outercortical bone layer of each adjacent bone portion is received within therespective first or second gaps for being clamped between the upper andlower jaws.
 10. The bone plate according to claim 1, wherein the boneplate is formed from a unitary resilient material.
 11. A method forstabilizing adjacent bone portions, comprising: providing a bone platecomprising at least one pair of opposing jaw members; inserting one ofthe jaw members of the first pair of opposing jaw members into theintramedullary canal of a first bone portion; positioning the other jawmember of the first pair of opposing jaw members adjacent the outsidesurface of the first bone portion; and fixing the cortical bone of thefirst bone portion between the first pair of opposing jaw members; andpositioning a second bone portion adjacent the first bone portion topromote fusion of the adjacent bone portions.
 12. The method of claim11, wherein the bone plate comprises a second pair of opposing jawmembers, and the method further comprises: inserting one of the jawmembers of the second pair of opposing jaw members into theintramedullary canal of the adjacent second bone portion; positioningthe other jaw member of the second pair of opposing jaw members adjacentthe outside surface of the second bone portion; fixing the cortical boneof the second bone portion between the second pair of opposing jawmembers.
 13. The method of claim 11, wherein the step of fixing thecortical bone of the first bone portion comprises clamping the corticalbone between the opposing jaw members.
 14. The method of claim 11,further comprising shifting the jaw members to an expanded position bymoving at least one of the jaw members away from the other prior toinserting the jaw member into the intramedullary canal.
 15. The methodof claim 14, wherein fixing the cortical bone comprises releasing the atleast one jaw member such that the jaw member returns towards anunexpanded configuration to clamp the cortical bone between the opposingjaw members.
 16. The method of claim 14, wherein shifting the jawmembers to an expanded position includes manipulating the at least onejaw member with a lever.
 17. The method of claim 12, further comprisingshifting the jaw members of each pair to an expanded position by movingat least one of the jaw members of each pair away from the otheropposing jaw member prior to inserting the one jaw member of each pairinto the respective intramedullary canal.
 18. The method of claim 17,wherein shifting the jaw members of each pair to an expanded positionincludes manipulating the at least one jaw member of each pair with aseparate lever.
 19. The method of claim 17, wherein shifting the jawmembers of each pair to an expanded position includes shifting theseparate levers together and connecting the separate levers so that thejaw members will remain in the expanded position until the levers aredisconnected.
 20. The method of claim 11, wherein fixing the corticalbone of the first bone portion between the first pair of opposing jawmembers comprises positioning an anchor device into engagement with thecortical bone.
 21. The method of claim 11, wherein position the secondbone portion adjacent the first bone portion includes bringing thesecond bone portion into abutting engagement with a transverse supportportion of the bone plate to minimize the gap between the adjacent boneportions to promote fusion thereof.